Tryptyr
Generic: acoltremon
0.003% — Drops
Anti-Inflammatory / Immunomodulator
Also known as:
TRYPTYR SOLN .003%
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Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Blue Cross Blue Shield Federal
2 plansCigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Bronze 5500 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Silver 5000 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Silver 3600 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Silver 3000 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Bronze CMS Standard | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Silver CMS Standard | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Gold CMS Standard | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect myDiabetesCare Bronze | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect myDiabetesCare Silver | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Gold 1500 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Bronze RD CMS Standard | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Silver RD CMS Standard | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Gold RD CMS Standard | Tier 4 - Non-Preferred | — | — | ✓ | QL |
| Connect Bronze 6500 Indiv Med Deductible | Tier 4 - Non-Preferred | — | — | ✓ | QL |
Medicare Part D
25 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Humana Gold Plus H6622-057 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus H6622-060 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Choice H8145-004 (PFFS) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus H6622-061 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus H1036-137 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus H1036-233 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Dual Select H1036-307 (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus - Diabetes and Heart (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus Giveback H1036-318 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus H1036-335 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| HumanaChoice Giveback H5216-017 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| HumanaChoice H5216-211 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Full Access H5525-034 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| HumanaChoice Giveback H5525-035 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| HumanaChoice SNP-DE H5525-036 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| HumanaChoice H5525-049 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| HumanaChoice H5525-050 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| HumanaChoice H5525-070 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Dual Select H5525-072 (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| HumanaChoice H5525-083 (PPO) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus H6622-025 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Gold Plus H6622-026 (HMO-POS) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |
| Humana Dual Select H6622-027 (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | ✓ 60 per 30 days | QL |